Community perceptions on sexual activity and stroke

Between October 2017 and February 2018, I was in Ghana to conduct a study on local communities’ perceptions on chronic illnesses and stroke. We conducted 30 Focus Group Discussions (FGDs) in five communities which were located in five major cities in the country (i.e. Accra, Kumasi, Cape Coast, Keta and Tamale). When we asked the local residents about their perceptions on causes of stroke, they mentioned factors such as hypertension, diabetes, poor lifestyles (e.g. excessive alcohol consumption, physical inactivity, and smoking), poor dietary practices, and supernatural factors (e.g. witchcraft, sorcery, curses, etc.). During the group discussions, one thing that was really striking to me and my research team was when the community participants mentioned sexual activity as one of the main causes of stroke. When this idea came up in the first community that we went to, we decided to explore this further in the remaining four communities and similar discussions ensued.

Particularly, community residents mentioned that frequency of sexual activity, sex positions (i.e. having sex while standing and kneeling, and having sex on the floor), having sex in old age and engagement in indiscriminate sex (i.e. womanising for men and promiscuity for women) were major causes of stroke in their communities. This was quite astounding because this kind of knowledge has not featured in medical discourse and is not a common knowledge in socio-cultural explanations of the illness in Ghana. What is unclear is how and when this knowledge developed and permeated community discourse on stroke in Ghanaian society. During my discussion with the local community residents, I realised that the perception on causal association between sexuality and stroke is more or less a recent knowledge that has swiftly moved across many Ghanaian communities and gaining dominance. What is of much concern to me, as a researcher, is why the participants subscribed to this kind of knowledge.

Some people have argued that since sexual activity and stroke usually takes place around the same time (i.e. evening and early in the morning), people are more likely to establish causation even though this is a misconception (Ebrahim et al., 2002). Medical literature suggests that although sexual activity does not cause stroke, it can trigger a stroke. Cases of people who developed stroke shortly after sexual intercourse have been reported in North America and Europe; however, further examinations of these cases by health professionals showed that the underlying predisposing factors of stroke for such patients include sudden constriction of blood vessels (vasospasm) (Levy, 1981), cerebral haemorrhage or subarachnoid haemorrhage (Jimbo et al., 2000), use of birth control pills (a medication known for increasing one’s risk for developing blood clots) , a hole in the heart (foramen ovale ) (Grayson, 2008), and undetected high blood pressure (Miller, 2017). It is also a medical fact that male sexual activity increases heart rate, blood pressure and plasma noradrenaline levels and this might trigger a haemorrhagic stroke in susceptible individuals (Levine et al., 2012). Conversely, a study conducted in Caerphilly found no association between frequency of sexual intercourse and ischemic stroke (Ebrahim et al., 2002). The main reason given for this is that during sexual intercourse, there is a decrease of cerebral blood flow in all cortical areas except in the right prefrontal cortex, and these changes are unlikely to precipitate an ischaemic stroke. From a medical perspective, therefore, there is no causal link between sexual activity and stroke, although living with stroke can result in sexual dysfunctions (American Heart Association, 2014). Also, knowing that the medical notion of an illness is usually monolithic and sometimes contradicts local community perceptions (Sanuade, 2018), it is important to understand the context of sexuality within the broader Ghanaian society. This may, perhaps, provide an explanation on why local community residents linked sexual activity with stroke onset.

In traditional Ghanaian society, sex discussion with youths was seen as a taboo and no formal sex education occurred in the transition from youth to adulthood (Anarfi and Owusu, 2011). Any youth who tried to ask questions about sexual issues was seen as disrespectful and disobedient and would be insulted or ignored because these issues were considered to be for adults only. There were particularly unique norms and practices that regulated sexual activities and these came with relevant sanctions when norms were breached. These norms existed to prevent promiscuity and premarital sex among youths and this was because many of the ethnic groups in Ghana attached great importance to chastity. There was, however, gender imbalance to this because many of the traditional sex education focused more on girls. In some of the traditional practices, while there were punishments for young women who engaged in premarital sex, men were treated very leniently. Further, as in many African countries, issues about sex in Ghana are also looked at from the perspective of morality and the link between religion and morality is more or less highly inseparable. From the religious perspective, discussion about sex in the presence of the youths is seen as encouraging immorality. Some religious leaders believe that this can make the youths indulge in sexual experimentation. Hence, the church often provides moral education instead of sex education. In addition, it is also a Christian dogma that sexual activity is expected to take place within the confines of marriage; even within marriage, sex is expected to be with one’s partner as fornication and adultery are frowned upon.

Nevertheless, the interactions of education, urbanization, internet, and western media have weakened the influence of religion and the traditional social control of sexual activities in Ghana. Particularly, urbanization, modernization and access to the internet have changed the phase of access to sex information. Currently, there is a growing sex consciousness and one can say that the Ghanaian society is becoming more sexualised than ever before. Sexually explicit images are projected and subtly woven into many areas such as adverts, billboards, media, local Ghallywood movies, other entertainment industries such as music and videos, and even when promoting regular products such as jeans, T-shirts, television, fragrance, etc. Discussions such as benefits of sex, how to satisfy one’s partner in bed, sex positions that can enhance sexual satisfaction and list of fruits or diets that can help boost sexual performance have become a regular feature in the media. There are also several newspaper publications that provide recommendations on the use of natural remedies to fix ejaculation problems, weak erection problems, small ‘manhood’ problems and other problems during sexual intercourse. As a result, there is a rise in the use of sex enhancing products to boost sexual functions. There are currently many outlets where sex enhancing products are being sold either legally or illegally. It is not uncommon to hear older adults say that Ghana is going through a phase of moral decadence due to an increase in premarital and extramarital affairs. There are also increasing cases of rape, sexual assault of children and different forms of sexual exploitation in the country. All of these show the growing ‘oversexualisation’ of Ghanaians which may partly explain local community perceptions on the causal association between sexuality and stroke.

In conclusion, this write-up provides interesting insights into the relationship between sexuality and stroke from local community perspectives. Based on existing studies, it is clear that living with stroke usually comes with several complications which include sexual dysfunctions; however, the causal relationship between sexual activity and stroke remains inconclusive. Nonetheless, local community residents in Ghana hold the view that sexual activity causes stroke and this view probably emerged from the growing sex consciousness in the country, triggered by the increase in sexually explicit images, sex exploitation, and poverty. Apart from the fact that it is important that these community perceptions need to be taken into consideration when developing intervention strategies for stroke in the country, deeper societal issues such as poverty, sex ‘miscommunication’, and how to minimise sex exploitation, need to be addressed.

Sanuade, O. Understanding the cultural meanings of stroke in the Ghanaian setting: A qualitative study exploring the perspectives of local community residents [version 1; referees: 2 approved with reservations]. Wellcome Open Res 2018, 3:87

About Oluwatobi Sanuade

Olutobi is currently a Research Associate at UCL. As part of the Wellcome Trust-funded project at UCL, Olutobi will be researching the history of chronic and non-communicable diseases (NCDs) in Ghana, including their interaction with infectious disease and their relationship to socio-economic status and demographic factors. Building on his earlier work, he will engage with health professionals, policy makers, people living with NCDs (and their caregivers) and lay individuals to determine how they make sense of chronic NCDs.

Recent blog posts

Sign up to our Newsletter

Email Address*

First Name

Last Name

* = required field

Chronic Disease in Sub-Saharan Africa

A critical history of an ‘epidemiological transition’

The project seeks to critically evaluate the history of what is viewed as an ‘epidemic’ of chronic and non-communicable diseases in sub-Saharan Africa and provide an historical account of the evolution of chronic and non-communicable diseases in Africa, going beyond a simple account of ‘transition’, and to contribute to wider debates on the nature of epidemiological change.